Impact of corticosteroids and immunosuppressive therapies on symptomatic SARS-CoV-2 infection in a large cohort of patients with chronic inflammatory arthritis

Abstract Background Prevalence and outcomes of coronavirus disease (COVID)-19 in relation to immunomodulatory medications are still unknown. The aim of the study is to investigate the impact of glucocorticoids and immunosuppressive agents on COVID-19 in a large cohort of patients with chronic immune-mediated inflammatory arthritis. Methods The study was conducted in the arthritis outpatient clinic at two large academic hospitals in the COVID-19 most endemic area of Northern Italy (Lombardy). We circulated a cross-sectional survey exploring the prevalence of severe acute respiratory syndrome-coronavirus-2 nasopharyngeal swab positivity and the occurrence of acute respiratory illness (fever and/or cough and/or dyspnea), administered face-to-face or by phone to consecutive patients from 25 February to 20 April 2020. COVID-19 cases were defined as confirmed or highly suspicious according to the World Health Organization criteria. The impact of medications on COVID-19 development was evaluated. Results The study population included 2050 adults with chronic inflammatory arthritis receiving glucocorticoids, conventional-synthetic (cs), or targeted-synthetic/biological (ts/b) disease-modifying drugs (DMARDs). Laboratory-confirmed COVID-19 and highly suspicious infection were recorded in 1.1% and 1.4% of the population, respectively. Treatment with glucocorticoids was independently associated with increased risk of COVID-19 (adjusted OR [95% CI] ranging from 1.23 [1.04–1.44] to 3.20 [1.97–5.18] depending on the definition used). Conversely, patients treated with ts/bDMARDs were at reduced risk (adjusted OR ranging from 0.46 [0.18–1.21] to 0.47 [0.46–0.48]). No independent effects of csDMARDs, age, sex, and comorbidities were observed. Conclusions During the COVID-19 outbreak, treatment with immunomodulatory medications appears safe. Conversely, glucocorticoids, even at low-dose, may confer increased risk of infection. Trial registration Retrospectively registered. Not applicable.

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Impact of corticosteroids and immunosuppressive therapies on symptomatic SARS-CoV-2 infection in a large cohort of patients with chronic inflammatory arthritis

10.21203/rs.3.rs-51667/v2 ◽

2020 ◽

Author(s):

Ennio Giulio Favalli ◽

Serena Bugatti ◽

Catherine Klersy ◽

Martina Biggioggero ◽

Silvia Rossi ◽

...

Keyword(s):

Inflammatory Arthritis ◽

Immunosuppressive Agents ◽

Large Cohort ◽

World Health ◽

Nasopharyngeal Swab ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Chronic Inflammatory Arthritis ◽

Increased Risk ◽

The Impact

Abstract Background: Prevalence and outcomes of Coronavirus Disease (COVID)-19 in relation to immunomodulatory medications are still unknown. The aim of the study is to investigate the impact of glucocorticoids and immunosuppressive agents on COVID-19 in a large cohort of patients with chronic immune-mediated inflammatory arthritis.Methods: The study was conducted in the arthritis outpatient clinic at two large Academic Hospitals in the COVID-19 most endemic area of Northern Italy (Lombardy). We circulated a cross-sectional survey exploring the prevalence of Severe Acute Respiratory Syndrome-Coronavirus-2 nasopharyngeal swab positivity and the occurrence of acute respiratory illness (fever and/or cough and/or dyspnea), administered face-to-face or by phone to consecutive patients from 25th February to 20th April 2020. COVID-19 cases were defined as confirmed or highly suspicious according to the World Health Organization criteria. The impact of medications on COVID-19 development was evaluated. Results: The study population included 2050 adults with chronic inflammatory arthritis receiving glucocorticoids, conventional-synthetic (cs), or targeted-synthetic/biological (ts/b) disease-modifying drugs (DMARDs). Laboratory-confirmed COVID-19 and highly suspicious infection were recorded in 1.1% and 1.4% of the population, respectively. Treatment with glucocorticoids was independently associated with increased risk of COVID-19 (adjusted OR [95% CI] ranging from 1.23 [1.04-1.44] to 3.20 [1.97-5.18] depending on the definition used). Conversely, patients treated with ts/bDMARDs were at reduced risk (adjusted OR ranging from 0.46 [0.18-1.21] to 0.47 [0.46-0.48]). No independent effects of csDMARDs, age, sex, and comorbidities were observed.Conclusions: During the COVID-19 outbreak, treatment with immunomodulatory medications appears safe. Conversely, glucocorticoids, even at low-dose, may confer increased risk of infection.Trial registration: retrospectively registered

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Impact of Corticosteroids and Immunosuppressive Therapies on Symptomatic SARS-CoV-2 Infection in a Large Cohort of Patients with Chronic Inflammatory Arthritis

10.21203/rs.3.rs-51667/v1 ◽

2020 ◽

Author(s):

Ennio Giulio Favalli ◽

Serena Bugatti ◽

Catherine Klersy ◽

Martina Biggioggero ◽

Silvia Rossi ◽

...

Keyword(s):

Inflammatory Arthritis ◽

Immunosuppressive Agents ◽

Large Cohort ◽

World Health ◽

Nasopharyngeal Swab ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Chronic Inflammatory Arthritis ◽

Increased Risk ◽

The Impact

Abstract Background: Prevalence and outcomes of Coronavirus Disease (COVID)-19 in relation to immunomodulatory medications are still unknown. The aim of the study is to investigate the impact of glucocorticoids and immunosuppressive agents on COVID-19 in a large cohort of patients with chronic immune-mediated inflammatory arthritis.Methods: The study was conducted in the arthritis outpatient clinic at two large Academic Hospitals in the COVID-19 most endemic area of Northern Italy (Lombardy). We circulated a cross-sectional survey exploring the prevalence of Severe Acute Respiratory Syndrome-Coronavirus-2 nasopharyngeal swab positivity and the occurrence of acute respiratory illness (fever and/or cough and/or dyspnea), administered face-to-face or by phone to consecutive patients from 25th February to 20th April 2020. COVID-19 cases were defined as confirmed or highly suspicious according to the World Health Organization criteria. The impact of medications on COVID-19 incidence was evaluated. Results: The study population included 2050 adults with chronic inflammatory arthritis receiving glucocorticoids, conventional-synthetic (cs), or targeted-synthetic/biological (ts/b) disease-modifying drugs (DMARDs). Laboratory-confirmed COVID-19 and highly suspicious infection were recorded in 1.1% and 1.4% of the population, respectively. Treatment with glucocorticoids was independently associated with increased risk of COVID-19 (adjusted OR [95% CI] ranging from 1.23 [1.04-1.44] to 3.20 [1.97-5.18] depending on the definition used). Conversely, patients treated with ts/bDMARDs were at reduced risk (adjusted OR ranging from 0.46 [0.18-1.21] to 0.47 [0.46-0.48]). No independent effects of csDMARDs were observed.Conclusions: During the COVID-19 outbreak, treatment with immunomodulatory medications appears safe. Conversely, glucocorticoids, even at low-dose, may confer increased risk of infection.Trial registration: retrospectively registered

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Impact of corticosteroids and immunosuppressive therapies on symptomatic SARS-CoV-2 infection in a large cohort of patients with chronic inflammatory arthritis

10.21203/rs.3.rs-51667/v3 ◽

2020 ◽

Author(s):

Ennio Giulio Favalli ◽

Serena Bugatti ◽

Catherine Klersy ◽

Martina Biggioggero ◽

Silvia Rossi ◽

...

Keyword(s):

Inflammatory Arthritis ◽

Immunosuppressive Agents ◽

Large Cohort ◽

World Health ◽

Nasopharyngeal Swab ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Chronic Inflammatory Arthritis ◽

Increased Risk ◽

The Impact

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Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners

Canadian Medical Education Journal ◽

10.36834/cmej.71149 ◽

2021 ◽

Author(s):

Allison Brown ◽

Aliya Kassam ◽

Mike Paget ◽

Kenneth Blades ◽

Megan Mercia ◽

...

Keyword(s):

Medical Education ◽

Medical Training ◽

Well Being ◽

World Health ◽

Future Research ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The World ◽

Geographic Regions ◽

The Impact

Background: The evidence surrounding the impact of COVID-19 on medical learners remains anecdotal and highly speculative despite the anticipated impact and potential consequences of the current pandemic on medical training. The purpose of this study was to explore the extent that COVID-19 initially impacted medical learners around the world and examine global trends and patterns across geographic regions and levels of training. Methods: A cross-sectional survey of medical learners was conducted between March 25–June 14, 2020, shortly after the World Health Organization declared COVID-19 a pandemic. Results: 6492 learners completed the survey from 140 countries. Most medical schools removed learners from the clinical environment and adopted online learning, but students reported concerns about the quality of their learning, training progression, and milestone fulfillment. Residents reported they could be better utilized and expressed concerns about their career timeline. Trainees generally felt under-utilized and wanted to be engaged clinically in meaningful ways; however, some felt that contributing to healthcare during a pandemic was beyond the scope of a learner. Significant differences were detected between levels of training and geographic regions for satisfaction with organizational responses as well as the impact of COVID-19 learner wellness and state-trait anxiety. Conclusions: The disruption to the status quo of medical education is perceived by learners across all levels and geographic regions to have negatively affected their training and well-being, particularly amongst postgraduate trainees. These results provide initial empirical insights into the areas that warrant future research as well as consideration for current and future policy planning.

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Decisions and repercussions of second victim experiences for mothers in medicine (SAVE DR MoM)

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-008372 ◽

2019 ◽

Vol 28 (7) ◽

pp. 564-573 ◽

Cited By ~ 5

Author(s):

Kiran Gupta ◽

Sarah Lisker ◽

Natalie A Rivadeneira ◽

Christina Mangurian ◽

Eleni Linos ◽

...

Keyword(s):

Diagnostic Errors ◽

Free Text ◽

Cross Sectional Survey ◽

Survey Period ◽

Cross Sectional ◽

Family Responsibilities ◽

Increased Risk ◽

Second Victim ◽

The Impact ◽

Single Question

BackgroundThe second victim effect is defined as emotional distress experienced by providers involved in mistakes. This study characterises events contributing to the second victim effect among a diverse sample of physician mothers, describes the impact on both provider and patient and seeks to determine the association between experiencing a mistake and burnout.MethodsIn this mixed-methods study, an anonymous, cross-sectional survey was posted to an online network of over 65 000 physician mothers on 17 June 2016. Self-reported involvement in a mistake provided opportunity to describe the error and impact on both provider and patient. Free-text responses were qualitatively coded to identify error types. Hypothesising that making a mistake contributes to burnout, self-reported burnout was examined using a single question. We used logistic regression to estimate the association between involvement in a mistake and burnout, adjusting for practice years, setting and specialty.Results5782 members completed the survey for an estimated response rate of 16.5% based on 34956 active users during the survey period. 2859 respondents reported involvement in a mistake (49%), which was associated with higher reported burnout (p<0.0001). 56% of those reporting a mistake provided descriptions. Qualitative analysis revealed that self-reported treatment errors were more common and diagnostic errors were most often reported to result in greater patient harm. Of those involved in a mistake, 82% reported feelings of guilt; 2.2% reported reducing clinical workload, taking leave or leaving the profession.ConclusionsPhysician mothers involved in errors experience negative outcomes and may be at increased risk for burnout. Additional research should focus on strategies to mitigate burnout associated with the second victim effect, particularly among women physicians and those with family responsibilities.

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A cross-sectional survey of COVID-19 preparedness in governmental hospitals of North-West Ethiopia

SAGE Open Medicine ◽

10.1177/2050312121993292 ◽

2021 ◽

Vol 9 ◽

pp. 205031212199329

Author(s):

Abebe Tiruneh ◽

Tikuneh Yetneberk ◽

Denberu Eshetie ◽

Bassazinew Chekol ◽

Moges Gellaw

Keyword(s):

World Health Organization ◽

Acceptable Level ◽

World Health ◽

Treatment Center ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The World ◽

Health Organization ◽

The Impact ◽

South Gondar

Introduction: The novel coronavirus was first reported in December 2019, from Wuhan, China, and it has been declared as a pandemic by World Health Organization on 7 January 2020, and from that time till now the disease transmitted across the world. Hospitals need to be prepared for the overwhelming COVID-19 cases in their respective hospitals. Objectives: The objective of this study was to assess the level of hospital preparedness for COVID-19 in South Gondar Zone Governmental Hospitals, 2020. Methods: The institutionally based survey was conducted in South Gondar Zone Hospitals from 20 July to 25 July 2020. We used the World Health Organization preparedness checklist for COVID-19, and the checklist has three options for eight hospitals (not started, in progress, and started), so each hospital evaluated out of 208 points (104 items × 2) to assess each hospital their preparedness based on the checklist. Statistical Package for the Social Sciences, Version 21, is used for the analysis of the data. We used descriptive statistics and explained by using text and tables. Results: We evaluated all eight hospitals in these zone hospitals and only one hospital was in an acceptable level of preparation (>146 points), three hospitals were in an insufficient level of preparation (73–145 points), and the other four hospitals were grouped under the unacceptable level of preparation (<72 points) for COVID-19. And in all hospitals, there was no laboratory diagnostic method and treatment center for the COVID-19 virus. Conclusion: From the level of COVID-19 pandemic preparation from eight hospitals, only one hospital reaches the level of an acceptable level of preparedness. Mobilizing the community and other stakeholders to equip the hospital with resources and prioritization is recommended to mitigate the impact of COVID-19.

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The impact of the COVID-19 pandemic on parents’ behavior toward scheduled pediatric vaccinations in Saudi Arabia

The Journal of Infection in Developing Countries ◽

10.3855/jidc.13765 ◽

2021 ◽

Vol 15 (08) ◽

pp. 1054-1058

Author(s):

Abdullah Saleh Al-Nafeesah ◽

Abdullah Saleh Aldamigh ◽

Basel Abdulrahman Almansoor ◽

Osama Al-Wutayd ◽

Ashwaq Ahmed AlE'ed

Keyword(s):

Logistic Regression ◽

Saudi Arabia ◽

Multiple Logistic Regression Analysis ◽

Binary Logistic Regression ◽

Cross Sectional Study ◽

World Health ◽

Online Questionnaire ◽

Cross Sectional ◽

Increased Risk ◽

The Impact

Introduction: Coronavirus disease (COVID-19) is caused by a newly discovered coronavirus and has resulted in a global pandemic. The World Health Organization recommended avoiding any delay or disruption of immunization services, as this could result in increases in outbreak-prone vaccine-preventable diseases. This study aimed to determine the impact of the COVID-19 pandemic on parents’ behaviour towards their children’s scheduled vaccinations. Methodology: This web-based cross-sectional study recruited 1,143 parents/guardians of children below six years of age living in Saudi Arabia between May 1 and May 30, 2020 via social media platforms. A self-developed online questionnaire consisting of eight items was used. Simple and multiple binary logistic regression was used to determine the factors associated with vaccine delay during the COVID-19 pandemic. Results: The parents/guardians were aged 20–60 years; 82% were aged between 20 and 39 years. It was found that 26% of parents did not vaccinate their children on time according to the national immunization schedule in regular situations, and 38% of parents reported delaying vaccination due to the COVID-19 pandemic. The multiple logistic regression analysis found that having two or more children, living in Riyadh or the Western region or not vaccinating children during regular situations were associated with an increased risk of vaccine delay during the COVID-19 pandemic. Conclusions: Delaying children’s vaccinations during the COVID-19 pandemic was influenced most by living in regions with high COVID-19 prevalence and having two or more children.

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Level of awareness, knowledge and perception on COVID-19 among pregnant women attending antenatal clinics in Central Hospital Benin City, Edo state

Annals of Clinical and Biomedical Research ◽

10.4081/acbr.2021.116 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Sunday Eghosasere Omozuwa ◽

Noel Ebehiremen Uwaibi

Keyword(s):

Pregnant Women ◽

Antenatal Clinic ◽

Viral Disease ◽

World Health ◽

Central Hospital ◽

Cross Sectional Survey ◽

Public Health Response ◽

Cross Sectional ◽

Benin City ◽

The Impact

Coronavirus disease (COVID-19) is an infectious viral disease caused by severe acute respiratory syndrome coronavirus-2, which affects mainly the respiratory system and was first discovered during an outbreak in Wuhan community in China December 2019. The outbreak was declared a pandemic by World Health Organization (WHO) March, 11th 2020 and a worldwide public health response has been engaged to address the impact. A descriptive cross sectional survey was utilized. A self- administered questionnaire on awareness, knowledge and perception of COVID-19 infection was administered to a total 420 pregnant women attending antenatal clinic in central Hospital Benin City for Data collection. Four hundred and fourteen (98.6%) of the respondents were aware of COVID-19 and 274 (66.2%) indicated television as their source of information. One hundred (24.2%) indicated radio while 92 (22.2%) implicated friends. One hundred and ninety seven (46.9%) of the respondents had good knowledge of COVID-19 while 68 (16.2%) had poor knowledge. There was a high level of awareness of COVID-19 among the pregnant women attending Antenatal clinic in central hospital Benin City and majority of them got their information from the television.

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Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners

10.1101/2020.09.01.20186304 ◽

2020 ◽

Author(s):

Allison Brown ◽

Aliya Kassam ◽

Mike Paget ◽

Kenneth Blades ◽

Megan Mercia ◽

...

Keyword(s):

Medical Training ◽

Well Being ◽

Cross Sectional Study ◽

World Health ◽

Future Research ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The World ◽

Geographic Regions ◽

The Impact

To broadly explore the extent that COVID-19 has initially impacted medical learners around the world and examine global trends and patterns across geographic regions and levels of training, a cross-sectional survey of medical learners was conducted between March 25-June 14th, 2020, shortly after the World Health Organization declared concurrent COVID-19 a pandemic. 6492 medical learners completed the survey from 140 countries, Students were concerned about the quality of their learning, training progression, and milestone fulfillment. Most trainees felt under-utilized and wanted to be engaged clinically in meaningful ways; however, some trainees felt that contributing to healthcare during a pandemic was beyond the scope of a medical learner. Statistically significant differences were detected between levels of training and geographic regions for satisfaction with organizational responses, the impact of COVID-19 on wellness, and state-trait anxiety. Overall, the initial disruption to medical training has been perceived by learners across all levels and geographic regions to have negatively affected their training and well-being, particularly amongst postgraduate trainees. These results provide initial insights into the areas that warrant future research as well as consideration for current and future policy planning, such as the policies for clinical utilization of medical learners during public health emergencies.

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Early negative life events during childhood and social anxietyin adulthood

European Psychiatry ◽

10.1016/s0924-9338(11)71851-x ◽

2011 ◽

Vol 26 (S2) ◽

pp. 140-140

Author(s):

C. Binelli ◽

A. Ortiz ◽

E. Gelabert ◽

J.A. Crippa ◽

S. Subirà ◽

...

Keyword(s):

Social Anxiety ◽

University Students ◽

Family Violence ◽

Life Events ◽

Emotional Abuse ◽

Negative Life Events ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Increased Risk ◽

The Impact

BackgroundAlthough there is considerable evidence on the impact of negative life events during childhood on the etiology of psychiatric disorders, little is known about the specific influence on the social anxiety disorder. The objective of the study was to examine this association.MethodIn a cross-sectional survey in 571 university students we analysed the association between loss of someone close, emotional abuse, physical abuse, family violence and sexual abuse with social anxiety assessed by the Liebowitz Social Anxiety Scale.ResultsTwenty percent of the sample had social anxiety and 50,6% had an early negative life events in childhood. After controlling for family psychiatric history and gender only family violence was associated with an increased risk of social anxiety (OR = 4.63; 95%CI = 1.13–18.9).ConclusionsThis study found childhood family violence associated with social phobia in university students.

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